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NPI Code Detail

MEDICARE: HEALTH SOURCE OF GREAT BEND INC

MEDICARE: HEALTH SOURCE OF GREAT BEND INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorDC008738PA

General Provider Information

NPI Number : 1770766958
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTH SOURCE OF GREAT BEND INC
Provider Business Mailing Address
First Line : 325 MAIN ST
Second Line : PO BOX 825
City : GREAT BEND
State : PA
Zip : 18821-9753
Country : US
Telephone Number : 570-879-2979
Fax Number : 570-879-5044
Provider Business Practice Location Address
First Line : 325 MAIN ST
Second Line :
City : GREAT BEND
State : PA
Zip : 18821-9753
Country : US
Telephone Number : 570-879-2979
Fax Number : 570-879-5044
Authorized Official
Title or Position : OWNER
Name : DR. GEORGE H STOVER III
Credential : DC
Telephone Number : 570-879-2979
Provider Enumeration Date : 12/11/2007
Last Update Date : 09/16/2013

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Directions to “HEALTH SOURCE OF GREAT BEND INC ” Practice Location

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